The Lived Experiences of Tobacco Use, Dependence, and Cessation

Mar 11, 2011

People with mental illness are more likely to be smokers than the general population. In fact, studies indicate that individuals with mental illness or addictions are two to three times more likely to be addicted to tobacco than are individuals in the general population. However, few studies have been conducted to determine why this is the case. Recently, Erica Singer Solway, PhD, MPH, MSW, conducted focus group interviews with people with mental illness to learn more about smoking among those with mental illness. Her findings have been published in the February 2011 issue of Health and Social Work.

She was interested to learn some of the reasons people with mental illness have for smoking. Some of those reasons are:

Managing stress: some of the subjects told her that smoking helped them to cope with the stress and daily obstacles and demands of a life with mental illness. Maintaining what mental health they do experience creates stress, for which cigarettes help them cope. Some even said that, feeling so limited in choices in many areas of their lives, they choose to continue to smoke as an expression of independence. One smoker said, “I want to keep smoking because I believe in individual freedom, and even though the whole world is down on cigarettes, I want to be able to smoke.”

Creating comfort: many of the subjects expressed a longing for calm and tranquility. Even though they recognized that cigarettes provided a “false sense of comfort,” they still found them useful to help them manage their emotions.

Being ‘a part of’: most interestingly, people with mental illness who smoke expressed the idea that smoking helped give them a sense of place or belonging. The need to avoid feeling different and the desire to fit in resulted in the decision to smoke, even it meant fitting in with “the fringe” rather than the mainstream population. A former smoker said, “I feel that mental health patients are made to feel apart from rather than a part of society and culture. So when you’re on the periphery or pushed to the periphery like that, you’re isolated and made to feel alone. So you pick up whatever tools you can find if you’re on the edge to try to feel a part of and make yourself a part of. Well, if you don’t fit in with the general population anymore, then you look for what the fringe population is doing, and the fringe population is smoking.”

The study indicated that tobacco use among people with mental illness is a result of complex personal and social experiences and phenomena that shape the opportunities and motivations for smoking and quitting. By and large, each participant, regardless of his or her smoking status, saw cigarettes as an effective and available tool for finding relief from pain, grief, anger, and sadness as well as fulfilling the needs to fit in, feel supported, and avoid withdrawal. Smoking among people with mental illness represents a layering of stigma in which the stigma associated with mental illness is coupled with the stigma associated with smoking. The overarching themes that emerged from the study were that smoking provides people with mental illness with perceptions of normalcy and belonging, and feelings of control. Smoking provides opportunities to fit in, even if it is with the fringes of society, and creates a sense of control for people who lack a sense of control over their lives and their stress.

This study presents important findings for professionals who work with people with mental illness, and who want to help them to quit (or not take up) smoking. By knowing the motivations of people with mental illness who smoke, social workers and other mental health professionals can tailor smoking cessation programs to their clients’ needs, and help them to live longer, healthier lives.

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